<scp>B</scp>ritish<scp>HIV</scp>Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012 (2014 interim review)

A, de Ruiter; Taylor, GP; Clayden, Polly; Dhar, Jyoti; Gandhi, Kate; Gilleece, Yvonne; Harding, Kate; P, Hay; Kennedy, Jane; Low‐Beer, Naomi; Lyall, Hermione; Palfreeman, Adrian; O’Shea, Siobhan; Tookey, P; Tosswill, Jennifer; Welch, S; Wilkins, E.G.L.

doi:10.1111/hiv.12185

Cited by 39 publications

(5 citation statements)

References 320 publications

(352 reference statements)

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“…At present, the threshold to recommend vaginal delivery varies from the 50 copies/mL in the British HIV association (BHIVA) [ 7 ] and the European AIDS Clinical Society (EACS) [ 8 ] guidelines to that of 400 copies/mL in France [ 9 ] and 1000 copies/mL in the Department of Health and Human Services (DHHS) guideline in the US [ 10 ]. In Finland, the clinical practice from the early 2000s has been to recommend vaginal delivery in HIV-infected mothers if the viral load is <1000 copies/mL.…”

Section: Introductionmentioning

confidence: 99%

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

et al. 2018

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IntroductionVaginal delivery has been recommended for more than ten years for women living with HIV (WLWH) with good virological control. However, in Europe most WLWH still deliver by cesarean section (CS). Our aim was to assess the rate of vaginal delivery and the indications for CS in WLWH over 20 years in a setting of low overall CS rate.Materials and methodsThis was a retrospective study of all WLWH delivering in Finland 1993–2013. We identified the women by combining national health registers and extracted data from patient files.ResultsThe study comprised 212 women with 290 deliveries. Over 35% of the women delivered several children during the study years. During 2000–2013, with consistent viral load monitoring, 80.0% showed HIV viral loads <50 copies/mL in the last measurement preceding the delivery. Altogether 74.5% of all WLWH delivered vaginally and the rate of both elective CS and emergency CS was 12.8% each. For most CSs (63.5%) the indication was obstetrical, for 28.4% it was avoiding HIV transmission and for 0.7% it was mother’s request. In hospitals with less than ten HIV-related deliveries during the study period, the rate of elective CS was higher than in more experienced hospitals (22.7% versus 10.6% [p = 0.024]). No perinatal HIV transmissions occurred.ConclusionsMost WLWH can achieve good virological control and deliver vaginally. This will help them to maintain their future child bearing potential and reduce CS-related morbidity.

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Section: Introductionmentioning

confidence: 99%

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

et al. 2018

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“…However, in the UK, the use of short-course cART in pregnancy remains an option for women with a CD4 + cell count above 350 cells/μl. Pregnant women with a CD4 + cell count of 350–500 cells/μl have the option of continuing cART use if there are no contraindications such as poor adherence, as are women with a CD4 + cell count more than 500 cells/μl with a discordant partner [ 5 ]. Thus, an increasing proportion of women now remain on cART after pregnancy.…”

Section: Introductionmentioning

confidence: 99%

The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy

Huntington¹,

Thorne²,

Newell

et al. 2015

Aids

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Objective:The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).Methods:Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006–2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan–Meier analysis; adjusted hazard ratios (aHRs) for the 0–3 and 3–12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.Results:In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0–7.7] experienced viral rebound by 3 months, and 2.2% (1.4–3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58–4.39)] but not during the 3–12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22–32%) experienced viral rebound by 3 months, and 3.0% (1.6–4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58–12.29); 3–12 months: aHR 4.05 (2.03–8.09)].Conclusion:In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.

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“…Due to the risk of viral rebound, treatment changes are not recommended where toxicity is mild but there is currently no agreement on how to manage pregnant women on ART who develop LEE. Close monitoring of liver biomarkers and any symptoms of toxicity, including rashes is important (27). Particularly with severe LEE, further tests are required since this could indicate obstetric complications.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy is associated with elevation of liver enzymes in HIV-positive women on antiretroviral therapy

Huntington¹,

Thorne²,

Newell

et al. 2015

Aids

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Objective:The objective of this study is to assess whether pregnancy is associated with an increased risk of liver enzyme elevation (LEE) and severe LEE in HIV-positive women on antiretroviral therapy (ART).Design:Two observational studies: the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC).Methods:Combined data from UK CHIC and NSHPC were used to identify factors associated with LEE (grade 1–4) and severe LEE (grade 3–4). Women starting ART in 2000–2012 were included irrespective of pregnancy status. Cox proportional hazards were used to assess fixed and time-dependent covariates including pregnancy status, CD4+ cell count, drug regimen and hepatitis B virus/hepatitis C virus (HBV/HCV) coinfection.Results:One-quarter (25.7%, 982/3815) of women were pregnant during follow-up, 14.2% (n = 541) when starting ART. The rate of LEE was 14.5/100 person-years in and 6.0/100 person-years outside of pregnancy. The rate of severe LEE was 3.9/100 person-years in and 0.6/100 person-years outside of pregnancy. The risk of LEE and severe LEE was increased during pregnancy [LEE: adjusted hazard ratio (aHR) 1.66 (1.31–2.09); severe LEE: aHR 3.57 (2.30–5.54)], including in secondary analyses excluding 541 women pregnant when starting ART. Other factors associated with LEE and severe LEE included lower CD4+ cell count (<250 cells/μl), HBV/HCV coinfection and calendar year.Conclusion:Although few women developed severe LEE, this study provides further evidence that pregnancy is associated with an increased risk of LEE and severe LEE, reinforcing the need for regular monitoring of liver biomarkers during pregnancy.

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BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

Cited by 39 publications

References 320 publications

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy

Pregnancy is associated with elevation of liver enzymes in HIV-positive women on antiretroviral therapy

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